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PAIN–Jaw, back, mid back/shoulder pain, heartburn (epigastric), Substernal MYOCARDIAL INFARCTION DURING–Any Chest Pain
Key words = priority: “Sudden” “Crushing” “radiating” NCLEX TIP O–Oxygen
SOB “dyspnea” “labored breathing” A–Asa
NAUSEA Vomiting “Abdominal pain” PATHO DIAGNOSTICS N–Nitro–under tongue x 3 Max
SWEATING “Diaphoresis” M–Morphine - Any pain after = MI (injury)
MI=Heart muscles DIE “necrosis” (minutes = muscle death) 1st–EKG AFTER–MI
PALE COOL SKIN “dusky”
Blockage of Coronary Artery “O2 Tube” (Any chest pain or MI symptoms) Clot Stabilization:
ANXIETY
Heparin: prevents CLOT growth (NOT dissolve only t-PA)
PTT: 46 - 70 “3 x MAX” Antidote: Protamine Sulfate
CAUSES Memory Trick: “HaPTT” frog
Heart Rest:
SODDA B–Beta Blockers (-lol) Atenolol
S–Stress, Smoking, Stimulants (caffeine, amphetamines) Blocks both BP & HR (Lol = Low BP & HR)
O–Obesity–(BMI over 25) CAUTION:
D–Diabetes & HTN (over 140/90) B–Bad for Heart Failure patients (CHF)
D–Diet (high cholesterol) animal fats B–Bradycardia (60 or Less) & BP low (HR LESS than 60)
A–African American males & Age (over 50) B–Breathing Problems “wheezing” (Asthma, COPD)
B–Blood sugar masking “hides s/s” (Diabetics)
*Men more than women C–Calcium Channel Blockers
Calms BP & HR-(AVOID Low Hr & BP)
PROGRESSION (Nifedipine, Diltiazem, Verapamil)
“Ischemic heart disease” -dipine “declined BP & HR”
CAM -zem “zen yoga for heart”
C–CAD “coronary artery disease” -amil “chill heart”
A–ACS “acute coronary syndrome” D–Dilators (vasOdilators = O2 to heart)
Angina - Stable “Safer”- relieved w/rest 2nd–LABS Nitroprusside (only for HTN crisis) & Isosorbide
Angina - Unstable “Unsafe” - Unrelieved T–Troponin (Over 0.5 ng/mL) Nitro “Pillow for heart”
M–MI (heart die) NO viagra “-afil” Sildenafil = DEATH!
T–Trauma (ONLY indicator of MI) Nitro drip: STOP if Systolic BP below 90 or 30 mmHg Drop
Other labs: Crp, Ckmb, SE: HA is Common + SLOW Positions changes “syncope”
Myoglobin, CRP (inflammation) DISCHARGE–GOING HOME
Heart Rest:
1st choice A–Ace (-pril) Lisonopril “chill pril”
TREATMENT: PHARMACOLOGY 2nd choice A–ARBs (-sartan) Losartan “relax man”
Antihypertensive (BP ONLY) *HOLD: Low BP (not HR)
PATIENT EDUCATION AC–Anti Clogging of Arteries Precautions:
A–Antiplatlet HOLD if: Platlets 50K or LESS A–Avoid Pregnancy
DRESS “below 50 gets risky” (not INR, not aPTT) A–Angioedema “thick tongue”
D–Diet low (sodium & fluids (2g/2L per day) A–ASA (Airway Risk) *only Ace *NCLEX TIP*
Prevent HF Heart Failure=Heavy Fluid C–Clopidogrel C–Cough *only Ace
Report "New, Rapid" Weight Gain-Water Gain! C–Cholesterol Lowering “-Statin” Creatinine (Kidney) (normal: 0.9 -1.2) *only Ace
R–Reduce Stress, Alcohol, Caffeine, Cholesterol (animal fats) Lovastatin “stay clean” E–Elevated K+ (normal 3.5-5.0) *NCLEX TIP*
E–Exercise (30 min x 5 days/wk) CAUTION: AVOID Salt Substitues + Green Leafy veggies
S–Smoking Cessation NO grapefruit • 1st–Cardiac Monitor
S–Sex (2 flights of stairs with NO SOB) NCLEX TIP Liver Toxic–report “clay colored stools” • High Potassium = High Pump
Muscle pain (Rhabdomyolysis risk) • Monitor: muscle cramps, spasms,
*AVOID NSAIDS (naproxen, ibuprofens) = increases CLOT risk! peaked T waves, ST changes
Late night–take at dinner
CATH LAB
C–Contrast = Kills Kidneys “Angioplasty, Angiogram, CABG”
A–Allergy to Iodine (warm flushing normal)
B–Bleeding–direct manual pressure (above site)
NO=heparin, warfarin, ASA, clopidogrel
C–Creatinine “Kidney” (normal: 0.9 - 1.2)
REPORT: Creatinine Over 1.3 & Urine below 30 ml/hr
STOP Metformin 48 hrs (before/after)
C–Can’t feel pulses (Pulses = Perfusion O2)
Diminished pulses (4-12 hrs post-procedure) MAX
PRIOITY:
Non palpable pedal pulse AFTER = CALL HCP (Dr.)
Key words: “cool leg, pulse non palpable,
present only with doppler US.”
COMPLICATIONS AFTER MI
ACUTE: (weeks after)
Cardiogenic Shock (severe hypotension)
V fib/V tach (no pulse) = DEADLY
Defibrillate=Don’t have a pulse
Cardioversion=Count a pulse *synchronize*
CHRONIC: (lifetime)
Heart failure “Heavy Fluid”
Rapid weight gain (Water Gain),
Worsening crackles (fluid in Lungs “pulmonary, edema”)
Sudden edema (JVD, peripheral edema “+1 pitting”)
#1 Priority–IV Diuretics–Furosemide, Bumetanide “dried”
(NOT isosorbide)
STRESS TEST
Non MI (Non priority) • Spot the Narrowing
TREADMILL STRESS TEST CHEMICAL: NUCLEAR PHARMACOLOGICAL STRESS TEST
STOP test: 24–48 hours BEFORE
chest pain NO Cigarettes, Caffeine (tea, soda, coffee) *NO DECAF
ST elevation NO Meds: Nitro, Beta Blocker, Theophylline (stimulant)
NPO (nothing oral) 4 hrs before/after
NOTES